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UNCLAS SECTION 01 OF 04 HANOI 001034
SIPDIS
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG);
OES/IHA (D.SINGER AND N.COMELLA)
BANGKOK FOR RMO, CDC, USAID/RDM/A - MFRIEDMAN
STATE PASS HHS FOR STEIGER
USDA FOR FAS/PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
DIRAFMIC FOR WENNER, MULLINS, WYMA
USAID FOR GHB, ANE/DCAROLL, SCLEMENTS AND PCHAPLIN
E.O. 12958: N/A
TAGS: AMEDAMGTCASCEAGRTBIOVMAFLU
SUBJECT: VIETNAM - AVIAN FLU: RECENT MEETINGS
REF: Hanoi 875 and previous
¶1. (SBU) Summary: This week new information emerged about
Avian Influenza H5N1 (AI) in meetings with CDC Influenza
Epidemiologist Keiji Fukuda, the Minister of Agriculture and
Rural Development, and the Donor Group. Experts now believe
that the virus may be changing in the north of Vietnam, but
do not yet have laboratory confirmation of this change. The
Government response and acknowledgement of the problem seems
to have improved significantly. The Vietnam Mission shares
the view of WHO and FAO that the next six months will be
critical to Vietnam's efforts to devise and implement an
effective strategy to control AI in poultry and prevent a
more serious outbreak in humans. Post recommends that the
USG speed up its consideration of a positive response to WHO
and FAO's call for donor assistance. End Summary.
¶2. New information emerged at three meetings this week in
Hanoi on Avian Influenza (AI). On April 25, the Ambassador,
USAID Country Manager and Consul attended a meeting of the
"donor group," hosted by the United Nations Development
Program (UNDP) with briefings by World Health Organization
(WHO) and United Nations Food and Agriculture Organization
(FAO) officials. The meeting focused on coordinating
international assistance for AI response. One of a team of
influenza experts from Australia, New Zealand and the United
States, Influenza Epidemiology Unit Leader at the U.S.
Centers for Disease Control and Prevention (CDC), Dr. Keiji
Fukuda briefed the DCM and Health Attache separately.
Finally, on April 26, the DCM, Health Attache and
Agricultural Attache met with the Minister of Agriculture
and Rural Development (MARD).
Vietnam's Response
------------------
¶3. (SBU) An important development is that the Government, at
every level, now openly acknowledges that AI is a major
problem. AI is now included in regular briefings to the
Prime Minister, according to FAO. There is still a tendency
to focus on economic costs while downplaying the social
health threat. But since Deputy Prime Minister (DPM) Nguyen
Tan Dzung publicly estimated that AI has shaved a half point
off this year's annual GDP growth rate, political attention
to the issue has been more readily forthcoming and seems to
be energizing discussions of response strategies. While DPM
Dzung has asserted publicly that the situation is contained,
he had acknowledged privately to WHO and FAO representatives
that that is not true. Moreover, he and other senior
officials appear to recognize the clear consequences of not
taking action.
¶4. (SBU) Minister of Agriculture and Rural Development
(MARD) Cao Duc Phat called for urgent action and assistance
in meetings with the DCM as well as with WHO and FAO
officials. To remove the threat of a human AI pandemic,
Vietnam must change its poultry industry, improve veterinary
services at the grassroots level and strengthen its capacity
to remove the virus, he stressed. The Ministry is
implementing all three activities. To do so, the Ministry
must strengthen surveillance to know where the virus is and
its characteristics. Minister Phat requested international
assistance to strengthen surveillance and diagnostic
laboratory capability. He asked for the immediate
assistance of laboratory experts for virus isolation and
characterization and for developing a suitable surveillance
program.
¶5. (U) MARD has a plan to compensate farmers, which it
calls a "farmer support plan." The Government is
uncomfortable with the term "compensation" because it
implies 100 percent compensation. The "farmer support plan"
has recently been augmented to provide 50 percent
reimbursement for poultry culled. To be effective, FAO
Country Representative Anton Rychner states that
reimbursement must be at least 75-80 percent, but even 100
percent reimbursement will not be fully effective. Rychner
believes it may be difficult to translate this to action
since MARD is a weak Ministry especially at the provincial
and local levels. For drastic action to take place in the
provinces, be it in the culling of poultry stocks or other
significant initiatives, clear direction must come from
senior political leadership in Hanoi, Rychner stressed.
¶6. (SBU) The WHO, FAO, and UNDP and Fukuda agree that the
GVN needs to define and prioritize its needs and focus on
developing response plans. Fukuda and the WHO both note
that the Ministry of Health (MOH) seems to be more fully
engaging recently and are hopeful that the MOH will be more
responsive in the coming weeks. The MOH has improved its
information sharing on human cases and research, but its
contributions to the plan for coordinated response and
assistance developed jointly by FAO, WHO and the GVN (Hanoi
875) are still minimal and slow. The MOH has yet to
identify its overall priorities for resources relative to
AI. MOH's National Institute of Hygiene and Epidemiology
(NIHE) seems more prepared and responsive. NIHE Director
Dr. Nguyen Tran Hien has outlined priorities and has made
requests to the Department of Health and Human Services to
meet NIHE's needs. The result is that the current plan is
reasonably informative on the poultry and agricultural steps
that MARD plans, but does not address the health side. Dr.
Fukuda reported that his discussions appear to have
convinced MOH hardliners that the situation needs rapid and
sustained attention, but that communication between the MOH
and MARD at the technical level remains weak.
¶7. (SBU) WHO Country Representative Hans Troedsson noted
that the lack of a Pandemic Emergency Response Plan is
critical. He explained that should a human pandemic occur,
there would be a one to two week window of opportunity, when
the number of cases would jump from tens to hundreds of
cases, in which it might be possible to halt further spread
of the pandemic. Beyond this window, once the number of
cases gets into the thousands and spreads geographically,
the pandemic will be out of control and cannot be contained.
He stressed the need for the GVN to develop a plan that can
be quickly enacted in this brief window of opportunity, to
limit travel, public movement and public exposure in order
to contain a pandemic.
¶8. (U) The WHO experts noted the risk that the Government's
attention may dwindle as the weather warms and the number of
new human cases and poultry outbreaks drops. The lack of
new cases would be purely a seasonal trend. The virus is
fully entrenched in Vietnam and the threat of pandemic is
not gone. WHO asked all governments to raise the issue at
high-level visits and meetings and to urge the GVN to
maintain momentum and focus on the issue.
Possible Change in Virus
------------------------
¶10. (SBU) Fukuda and the team of international experts
believe that they are seeing a change in the virus in the
north of Vietnam, but this has not yet been proven in
laboratory tests and is purely theoretical at this point.
They point to various factors including: a divergence in
epidemiology between the north and south of Vietnam, a
change in the age groups affected, a widening of the age
range among those infected (in the north three children
under the age of one were infected), a decreased fatality
rate, a widening range of symptoms reported, an increased
number of mild or non-symptomatic cases, an increased number
of clusters in the north, a widening gap in the time to
onset of disease between cases in clusters, and the fact
that the disease is lasting longer this year. There may be
other explanations, such as improved surveillance and
reporting, but taken together, Fukuda and his team believe
these factors may indicate that the virus has changed in the
north. WHO concurs with this assessment and now believes
the cases surrounding the Thai Binh cluster may indeed be
considered to be a fourth outbreak in humans. (Note: By
this definition, the first outbreak was from December 2003
to March 2004. The second occurred in July 2004. The third
began in December 2004 in the south of Vietnam and has not
yet concluded. End Note.)
¶11. (U) Based on Fukuda and his team's observations, WHO
will arrange a second, more comprehensive assessment of the
data by international influenza experts, including
epidemiologists and virologists in Manila. The meeting is
tentatively scheduled for the week of May 2 and there are
plans to include representatives from Cambodia and Thailand.
¶12. (SBU) If this change in the virus proves to be true, it
could mean an increased risk of a human pandemic. The
increased numbers of clusters may indicate improved
transmissibility. The decreased fatality rate and increased
number of mild or non-symptomatic cases may reduce detection
and containment. Finally, the changes now being detected
could be the first of more dramatic changes to come.
According to WHO's Hans Troedsson, if the virus has indeed
changed in the northern Vietnam, then that region is at
highest risk to be the source and epicenter of any global
pandemic.
¶13. (U) In an alternate explanation for the longer lasting
season this year, World Bank Representative Laurent Msellati
pointed out that seasonality may not simply be tied to the
weather and the environment. There are market seasons,
holiday seasons, and even economic trends that may come and
go just as the seasons do.
Other Information on the Disease
--------------------------------
¶14. (SBU) Fukuda provided some additional information. For
example, of the confirmed cases, 70 percent have known
contact with birds but 30 percent have not had contact with
birds; this pattern does not have seemed to have changed
since last year. Further, based on conversations with
physicians at Bach Mai Hospital, which has seen
approximately 40 AI patients, they appear to be harder to
treat successfully than SARS patients. Also, the physicians
note that antivirals (such as Oseltamivir) are not the
panacea. The consultation team asked the Bach Mai team to
organize their data as soon as possible. Finally, the
mortality difference between ducks and chickens - infected
chickens are dying rapidly while infected ducks appear
assymptomatic - is disconcerting. Ducks can spread AI virus
more widely into the environment over a long period of time.
¶15. (SBU) Minister Phat told the DCM that, based on serology
and virus isolation, there appears to be a change in the
pattern of the disease in poultry, which international
experts need to reassess. Observed changes include a drop in
the mortality rate in chickens from more than a 99 percent
in 2004 to identifying living, but infected chickens in 2005
and, in ducks, changes include assymptomatic, but infected
birds, and a change in the serologic pattern. Phat
suggested the observations might be real or also an artifact
of sampling errors and laboratory limitations.
Vaccination
-----------
¶16. (U) Poultry Vaccine: It is unclear whether the GVN has
decided to begin officially a poultry vaccination campaign.
On April 26, MARD reported that Vietnam had not decided yet
on an official policy. However, the World Bank's Msellati
said that MARD requested financial assistance for an
official vaccination campaign on April 22. Minister Phat
noted that MARD is still testing vaccine effectiveness, but
would like to begin vaccinating before next winter. He said
that they would be using imported vaccines because Vietnam's
capacity to develop a vaccine is limited. He requested the
assistance of U.S. animal vaccine experts to work with MARD
to help in planning for roll out of their vaccination
program.
¶17. (U) Human Vaccine: WHO's Troedsson reported that U.S.
development of a human vaccine is proceeding well. If there
are no glitches, it should be approved for use by the end of
this year. Production capacity and a delivery schedule were
not discussed. He expressed concern that the GVN does not
have a plan for who will receive the vaccine or how to
distribute it. Vietnam is also developing a human vaccine,
but its development is slower and Vietnam does not have
sufficient capacity for mass production.
¶18. (SBU) Comment: The Vietnam Mission shares the view of
WHO and FAO that the next six months will be critical to
Vietnam's efforts to devise and implement an effective
strategy to control AI in poultry and prevent a more serious
outbreak in humans. Post recommends that the USG speed up
its consideration of a positive response to WHO and FAO's
call for donor assistance. End Comment.
MARINE